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Article: Craniofacial resection for malignant melanoma of the skull base: Report of an International Collaborative Study

TitleCraniofacial resection for malignant melanoma of the skull base: Report of an International Collaborative Study
Authors
Issue Date2006
PublisherAmerican Medical Association. The Journal's web site is located at http://www.archoto.com
Citation
Archives Of Otolaryngology - Head And Neck Surgery, 2006, v. 132 n. 1, p. 73-78 How to Cite?
AbstractObjective: To report postoperative mortality, complications, and outcomes in a subset of patients with the histologic diagnosis of malignant melanoma extracted from an existing database of a large cohort of patients accumulated from multiple institutions. Design: Retrospective outcome analysis. Setting: Seventeen international tertiary referral centers performing craniofacial surgery for malignant skull base tumors. Patients: A total of 53 patients were identified from a database of 1307 patients who had craniofacial resection for malignant tumors at 17 institutions. The median age was 63 years. Of the 53 patients, 25 (47%) had had prior single modality or combined treatment, which included surgery in 22 (42%), radiation in 11 (21%), and chemotherapy in 2 (4%). The margins of resection were close or microscopically positive in 7 (13%). Adjuvant radiotherapy was given in 22 (42%), chemotherapy in 3 (6%), and vaccine or interferon therapy in 2 (4%). Complications were classified into overall, local, central nervous system, systemic, and orbital. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were determined using the Kaplan-Meier method. Predictors of outcome were identified by multivariate analysis. Results: Postoperative mortality occurred in 3 patients (6%) and postoperative complications were reported in 14 patients (26%). Local wound complications occurred in 6 patients (11%), central nervous system in 7 (13%), systemic in 3 (6%), and orbital in 1 (2%).With a median follow-up of 10 months (range, 1-159 months), the 3-year OS, DSS, and RFS rates were 28.2%, 29.7%, and 25.5%, respectively. The extent of orbital involvement and adjuvant postoperative radiation therapy (PORT) were independent predictors of DSS and OS on multivariate analysis, whereas only PORT was an independent predictor of RFS. Patients treated with PORT had significantly better 3-year OS (39% vs 18%; relative risk, 2.9; P=.007), DSS (41% vs 19%; relative risk, 3.0; P=.007), and RFS (39% vs 15%; relative risk, 4.2; P=.001). Conclusions: Craniofacial resection in patients with malignant melanoma of the skull base has mortality (6%) and complication rates (26%) comparable to other malignant tumors of the skull base. However, malignant melanoma is associated with a much poorer OS, DSS, and RFS. Adjuvant PORT correlated with improved 3-year OS, DSS, and RFS on multivariate analysis. These factors must be taken into account when considering craniofacial resection in a patient with malignant melanoma invading the skull base. ©2006 American Medical Association. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/172900
ISSN
2014 Impact Factor: 2.327
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorGanly, Ien_US
dc.contributor.authorPatel, SGen_US
dc.contributor.authorSingh, Ben_US
dc.contributor.authorKraus, DHen_US
dc.contributor.authorBridger, PGen_US
dc.contributor.authorCantu, Gen_US
dc.contributor.authorCheesman, Aen_US
dc.contributor.authorDe Sa, Gen_US
dc.contributor.authorDonald, Pen_US
dc.contributor.authorFliss, DMen_US
dc.contributor.authorGullane, Pen_US
dc.contributor.authorJanecka, Ien_US
dc.contributor.authorKamata, SEen_US
dc.contributor.authorKowalski, LPen_US
dc.contributor.authorLevine, PAen_US
dc.contributor.authorMedina Dos Santos, LRen_US
dc.contributor.authorPradhan, Sen_US
dc.contributor.authorSchramm, Ven_US
dc.contributor.authorSnyderman, Cen_US
dc.contributor.authorWei, WIen_US
dc.contributor.authorShah, JPen_US
dc.date.accessioned2012-10-30T06:25:40Z-
dc.date.available2012-10-30T06:25:40Z-
dc.date.issued2006en_US
dc.identifier.citationArchives Of Otolaryngology - Head And Neck Surgery, 2006, v. 132 n. 1, p. 73-78en_US
dc.identifier.issn0886-4470en_US
dc.identifier.urihttp://hdl.handle.net/10722/172900-
dc.description.abstractObjective: To report postoperative mortality, complications, and outcomes in a subset of patients with the histologic diagnosis of malignant melanoma extracted from an existing database of a large cohort of patients accumulated from multiple institutions. Design: Retrospective outcome analysis. Setting: Seventeen international tertiary referral centers performing craniofacial surgery for malignant skull base tumors. Patients: A total of 53 patients were identified from a database of 1307 patients who had craniofacial resection for malignant tumors at 17 institutions. The median age was 63 years. Of the 53 patients, 25 (47%) had had prior single modality or combined treatment, which included surgery in 22 (42%), radiation in 11 (21%), and chemotherapy in 2 (4%). The margins of resection were close or microscopically positive in 7 (13%). Adjuvant radiotherapy was given in 22 (42%), chemotherapy in 3 (6%), and vaccine or interferon therapy in 2 (4%). Complications were classified into overall, local, central nervous system, systemic, and orbital. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were determined using the Kaplan-Meier method. Predictors of outcome were identified by multivariate analysis. Results: Postoperative mortality occurred in 3 patients (6%) and postoperative complications were reported in 14 patients (26%). Local wound complications occurred in 6 patients (11%), central nervous system in 7 (13%), systemic in 3 (6%), and orbital in 1 (2%).With a median follow-up of 10 months (range, 1-159 months), the 3-year OS, DSS, and RFS rates were 28.2%, 29.7%, and 25.5%, respectively. The extent of orbital involvement and adjuvant postoperative radiation therapy (PORT) were independent predictors of DSS and OS on multivariate analysis, whereas only PORT was an independent predictor of RFS. Patients treated with PORT had significantly better 3-year OS (39% vs 18%; relative risk, 2.9; P=.007), DSS (41% vs 19%; relative risk, 3.0; P=.007), and RFS (39% vs 15%; relative risk, 4.2; P=.001). Conclusions: Craniofacial resection in patients with malignant melanoma of the skull base has mortality (6%) and complication rates (26%) comparable to other malignant tumors of the skull base. However, malignant melanoma is associated with a much poorer OS, DSS, and RFS. Adjuvant PORT correlated with improved 3-year OS, DSS, and RFS on multivariate analysis. These factors must be taken into account when considering craniofacial resection in a patient with malignant melanoma invading the skull base. ©2006 American Medical Association. All rights reserved.en_US
dc.languageengen_US
dc.publisherAmerican Medical Association. The Journal's web site is located at http://www.archoto.comen_US
dc.relation.ispartofArchives of Otolaryngology - Head and Neck Surgeryen_US
dc.subject.meshAdolescenten_US
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshAged, 80 And Overen_US
dc.subject.meshChilden_US
dc.subject.meshChild, Preschoolen_US
dc.subject.meshCranial Fossa, Anterior - Surgeryen_US
dc.subject.meshDisease-Free Survivalen_US
dc.subject.meshFacial Bones - Surgeryen_US
dc.subject.meshFemaleen_US
dc.subject.meshFollow-Up Studiesen_US
dc.subject.meshHumansen_US
dc.subject.meshInternational Cooperationen_US
dc.subject.meshMaleen_US
dc.subject.meshMelanoma - Epidemiology - Pathology - Surgeryen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshNeoplasm Invasivenessen_US
dc.subject.meshNeoplasm Recurrence, Localen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshSkull Base Neoplasms - Epidemiology - Pathology - Surgeryen_US
dc.subject.meshSurvival Rateen_US
dc.titleCraniofacial resection for malignant melanoma of the skull base: Report of an International Collaborative Studyen_US
dc.typeArticleen_US
dc.identifier.emailWei, WI: hrmswwi@hku.hken_US
dc.identifier.authorityWei, WI=rp00323en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1001/archotol.132.1.73en_US
dc.identifier.pmid16415433-
dc.identifier.scopuseid_2-s2.0-31144436580en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-31144436580&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume132en_US
dc.identifier.issue1en_US
dc.identifier.spage73en_US
dc.identifier.epage78en_US
dc.identifier.isiWOS:000234582500012-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridGanly, I=6701500102en_US
dc.identifier.scopusauthoridPatel, SG=7403903141en_US
dc.identifier.scopusauthoridSingh, B=7405639360en_US
dc.identifier.scopusauthoridKraus, DH=25947461900en_US
dc.identifier.scopusauthoridBridger, PG=6603845621en_US
dc.identifier.scopusauthoridCantu, G=7003498793en_US
dc.identifier.scopusauthoridCheesman, A=7003676128en_US
dc.identifier.scopusauthoridDe Sa, G=8561754500en_US
dc.identifier.scopusauthoridDonald, P=7103189603en_US
dc.identifier.scopusauthoridFliss, DM=7005455625en_US
dc.identifier.scopusauthoridGullane, P=7005484642en_US
dc.identifier.scopusauthoridJanecka, I=7005569375en_US
dc.identifier.scopusauthoridKamata, SE=35478208000en_US
dc.identifier.scopusauthoridKowalski, LP=7102126040en_US
dc.identifier.scopusauthoridLevine, PA=35386674700en_US
dc.identifier.scopusauthoridMedina Dos Santos, LR=6505883858en_US
dc.identifier.scopusauthoridPradhan, S=7202877432en_US
dc.identifier.scopusauthoridSchramm, V=35511790400en_US
dc.identifier.scopusauthoridSnyderman, C=7005989580en_US
dc.identifier.scopusauthoridWei, WI=7403321552en_US
dc.identifier.scopusauthoridShah, JP=7403266008en_US

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